Provider Demographics
NPI:1588110563
Name:SELGRADE, ELIZABETH STUENKEL (CO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:STUENKEL
Last Name:SELGRADE
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 LAKE WOODARD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3659
Mailing Address - Country:US
Mailing Address - Phone:919-231-6890
Mailing Address - Fax:
Practice Address - Street 1:3224 LAKE WOODARD DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3659
Practice Address - Country:US
Practice Address - Phone:919-231-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist